Round window coupled hearing systems and methods

ABSTRACT

A support can be configured for placement in the middle ear to couple a transducer to the round window, such that the transducer can be removed from the round window without damaging the round window. The support can be configured to couple the transducer to the sound window such that the support can be removed from the round window. The support may be configured to decouple the transducer from the round window such that the transducer can be removed from the middle ear of the user, for example when the support is affixed to the middle ear. Removal of the transducer from the middle ear without damaging the round window can allow safe removal of the transducer, for example when the patient wishes to receive MRI imaging.

CROSS-REFERENCES TO RELATED APPLICATIONS

The present application is a non-provisional of U.S. App. Ser. No.61/219,286 filed 22 Jun. 2009, entitled “Round Window Coupled HearingSystems and Methods”, the full disclosure of which is incorporatedherein by reference.

STATEMENT AS TO RIGHTS TO INVENTIONS MADE UNDER FEDERALLY SPONSOREDRESEARCH AND DEVELOPMENT

NOT APPLICABLE

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention is related to hearing systems, devices andmethods. Although specific reference is made to hearing aid systems,embodiments of the present invention can be used in many applications inwhich a signal is used to stimulate the ear.

People like to hear. Hearing allows people to listen to and understandothers. Natural hearing can include spatial cues that allow a user tohear a speaker, even when background noise is present. People also liketo communicate with those who are far away, such as with cellularphones.

Hearing devices can be used with communication systems to help thehearing impaired and to help people communicate with others who are faraway. Hearing impaired subjects need hearing aids to verballycommunicate with those around them. Open canal hearing aids have provento be successful in the marketplace because of increased comfort and animproved cosmetic appearance. Another reason why open canal hearingaides can be popular is reduced occlusion of the ear canal. Occlusioncan result in an unnatural, tunnel-like hearing effect which can becaused by large hearing aids which block the ear canal. In at least someinstances, occlusion be noticed by the user when he or she speaks andthe occlusion results in an unnatural sound during speech. However, aproblem that may occur with open canal hearing aids is feedback. Thefeedback may result from placement of the microphone in too closeproximity with the speaker or the amplified sound being too great. Thus,feedback can limit the degree of sound amplification that a hearing aidcan provide. Although feedback can be minimized by placing themicrophone outside the ear canal, this placement can result in thedevice providing an unnatural sound that is devoid of the spatiallocation information cues present with natural hearing.

In some instances, feedback may be decreased by using non-acoustic meansof stimulating the natural hearing transduction pathway, for examplestimulating the tympanic membrane, bones of the ossicular chain and/orthe cochlea. An output transducer may be placed on the eardrum, theossicles in the middle ear, or the cochlea to stimulate the hearingpathway. However, surgery is often needed to place a hearing device onthe ossicles or cochlea, and such surgery can involve delicate andcomplex movements to position the implant and can be somewhat invasive,for example with the cutting of bone, in at least some instances. Atleast some of the prior implants located on the ossicles or the cochleacan result in occlusion in at least some instances, and distortion ofthe sound can be perceptible in at least some instances.

Although it has been proposed to couple optically to a transducer placedon ossicles, in at least some instances the prior systems that transmitlight to a transducer can result in perceptible noise and distortion inthe optically transmitted signal, such that the sound quality of suchdevices can be less than ideal in at least some instances. For example,at least some optical systems may comprise non-linearity that candistort the signal and may result in user-perceptible distortion in atleast some instances. Work in relation to embodiments of the presentinvention also suggests that vibration of a photodetector can result indistortion of the transmitted signal, for example when vibration affectsoptical coupling from a light source to the photodetector. Also, atleast some of the proposed optically coupled devices have been affixedto vibratory structures of the ear, which can result in a userperceptible occlusion due to the mass of the device affixed to thevibratory structure of the ear.

Although coupling to the round window has been proposed, the roundwindow is a thin and delicate membrane and safe coupling to the roundwindow can be difficult to achieved to in at least some instances. Forexample, a permanent magnet securely fixed to the external surface ofthe round window of the cochlea can result in damage to the round windowin at least some instances, for example when the round window isremoved. Although a magnetic securely fixed to the round window mayresult in user perceived sound, in at least some instances a magnetpositioned on the structures of the ear may be sensitive to externalelectromagnetic fields that can result in a perceptible noise. Forexample a humming sound may be perceived by the user in at least someinstances. Also, it may be important for the patient to receive animaging study at some point during his or her life, and removal of amagnet securely fixed to the round window can be difficult in at leastsome instances. A magnet securely fixed to the round window may damagethe thin an sensitive tissue of the round window, such that cochlearfluid may leak from the round window and potentially damage the cochleaand permanently impair hearing in at least some instances.

2. Description of the Background Art

Patents and publications that may be relevant to the present applicationinclude: U.S. Pat. Nos. 3,585,416; 3,764,748; 3,882,285; 5,142,186;5,360,388; 5,554,096; 5,624,376; 5,795,287; 5,800,336; 5,825,122;5,857,958; 5,859,916; 5,888,187; 5,897,486; 5,913,815; 5,949,895;6,005,955; 6,068,590; 6,093,144; 6,139,488; 6,174,278; 6,190,305;6,208,445; 6,217,508; 6,222,302; 6,241,767; 6,422,991; 6,475,134;6,519,376; 6,620,110; 6,626,822; 6,676,592; 6,728,024; 6,735,318;6,900,926; 6,920,340; 7,072,475; 7,095,981; 7,239,069; 7,289,639;D512,979; 2002/0086715; 2003/0142841; 2004/0234092; 2005/0020873;2006/0107744; 2006/0233398; 2006/075175; 2007/0083078; 2007/0191673;2008/0021518; 2008/0107292; commonly owned U.S. Pat. Nos. 5,259,032;5,276,910; 5,425,104; 5,804,109; 6,084,975; 6,554,761; 6,629,922; U.S.Publication Nos. 2006/0023908; 2006/0189841; 2006/0251278; and2007/0100197. Non-U.S. patents and publications that may be relevantinclude EP1845919 PCT Publication Nos. WO 03/063542; WO 2006/075175;U.S. Publication Nos. Journal publications that may be relevant include:Ayatollahi et al., “Design and Modeling of Micromachines Condenser MEMSLoudspeaker using Permanent Magnet Neodymium-Iron-Boron (Nd—Fe—B)”,ISCE, Kuala Lampur, 2006; Birch et al, “Microengineered Systems for theHearing Impaired”, IEE, London, 1996; Cheng et al., “A siliconmicrospeaker for hearing instruments”, J. Micromech. Microeng., 14(2004) 859-866; Yi et al., “Piezoelectric microspeaker with compressivenitride diaphragm”, IEEE, 2006, and Zhigang Wang et al., “PreliminaryAssessment of Remote Photoelectric Excitation of an Actuator for aHearing Implant”, IEEE Engineering in Medicine and Biology 27th AnnualConference, Shanghai, China, Sep. 1-4, 2005. Other publications ofinterest include: Gennum GA3280 Preliminary Data Sheet, “Voyager TDTM.Open Platform DSP System for Ultra Low Power Audio Processing” andNational Semiconductor LM4673 Data Sheet, “LM4673 Filterless, 2.65 W,Mono, Class D audio Power Amplifier”; Puria, S. et al., Middle earmorphometry from cadaveric temporal bone micro CT imaging, Invited Talk.MEMRO 2006, Zurich; Puria, S. et al, A gear in the middle ear ARO 2007,Baltimore, Md.; and Lee et al., “The Optimal Magnetic Force For A NovelActuator Coupled to the Tympanic Membrane: A Finite Element Analysis,”Biomedical Engineering: Applications, Basis and Communications, Vol. 19,No. 3(171-177), 2007.

For the above reasons, it would be desirable to provide hearing systemswhich at least decrease, or even avoid, at least some of the abovementioned limitations of the prior hearing devices. For example, thereis a need to provide a safe and comfortable hearing device whichprovides hearing with natural qualities, for example with spatialinformation cues, and which allow the user to hear with less occlusion,distortion and feedback than prior devices.

BRIEF SUMMARY OF THE INVENTION

Embodiments of the present invention provide improved hearing systems,devices and methods that overcome at least some of the limitations ofthe prior hearing devices. A support can be configured for placement inthe middle ear to couple a transducer to the round window, such that thetransducer can be removed from the round window without damaging theround window. The support can be configured to couple the transducer tothe round window such that the support can be removed from the roundwindow. Alternatively or in combination, the support may be configuredto decouple the transducer from the round window such that thetransducer can be removed from the middle ear of the user, for examplewhen the support is affixed to the middle ear. Removal of the transducerfrom the middle ear without damaging the round window can allow saferemoval of the transducer, for example when the patient wishes toreceive MRI imaging. For example, the transducer may comprise a magnetcoupled to the support to vibrate the round window in a firstconfiguration of the support, and the magnet may be removed from thesupport with a second configuration of the support. The transducer inthe middle ear can be configured to vibrate in response toelectromagnetic energy in many ways. For example, a coil may bepositioned in the ear canal to couple to the magnet. Alternatively,electromagnetic energy comprising light energy can be transmitted alongthe ear canal to the transducer in the middle ear to vibrate thetransducer in response to light energy. For example, a photodetector canbe positioned in the middle ear to drive the transducer, which maycomprise a balance armature transducer coupled to the support, such thatinterference from magnetic fields is decreased.

In a first aspect, embodiments of the present invention provide a deviceto transmit sound to an ear of a user, in which the ear has a roundwindow. The device comprises a support configured to couple to the roundwindow, and a transducer configured to couple to the round window withthe support to transmit the sound.

In many embodiments, the support is disposed at least partially betweenthe transducer and the round window to inhibit contact of the transducerand round window.

In many embodiments, the support is configured to decouple from roundwindow without tearing tissue of the round window.

Alternatively or in combination, the support can be configured todecouple from the transducer when the support is affixed to the roundwindow. The support can be configured to affix to the round window, andthe support can be configured to decouple from the transducer to removethe transducer from a middle ear of the user when the support is affixedto the round window. The support comprises a first side to couple to theround window and a second side opposite the first side to couple to thetransducer.

In many embodiments, the support comprises an extension extending alongthe second side to inhibit tissue growth toward the transducer. Theextension may extend along the second side substantially parallel to thefirst side. The extension may extend away from the first side along thetransducer.

In many embodiments, the second side of the support comprises a recesssized to receive at least a portion of the transducer.

In many embodiments, the support comprises a structure configured tohold the transducer with a first configuration and release thetransducer with a second configuration. The structure may comprise anextension configured to extend from the support to the transducer anddecouple from the transducer to release the transducer.

In many embodiments, the transducer comprises at least one of a magnet,a coil, the coil and the magnet, a piezoelectric transducer, aphotostrictive transducer, a balanced armature transducer or amagnetostrictive transducer. For example, the transducer may comprisethe magnet and wherein the magnet is coupled to the support. The supportmay comprise a first side configured to couple to the round window and asecond side configured to couple to the magnet. The support may comprisea first configuration with to couple to the magnet and a secondconfiguration to release the magnet.

In many embodiments, the support comprises a soft biocompatible materialconfigured to conform to the round window. The support may comprise athin flexible material configured to deform with the round window inresponse to the sound.

In many embodiments, support is composed of a material comprising atleast one of collagen, silicone, hydrogel, biocompatible plastic, orelastomer.

In many embodiments, the support is configured to couple to a mucosa,for example a mucosal tissue, disposed over the round window.

In many embodiments, the support is configured to the round window witha liquid. For example, the liquid comprises an oil.

In many embodiments, the support comprises a first side configured tocouple to the round window and a second side configured to couple to thesupport. The support may comprise a first configuration to couple to thetransducer and a second configuration to decouple from the transducer toremove the transducer from the middle ear.

In many embodiments, the transducer comprises the coil and the coil isconfigured for placement in an ear canal of the user to couple to themagnet.

In many embodiments, the transducer comprises the balanced armaturetransducer and a reed of the balanced armature tranducer is coupled tothe support to vibrate the round window. A structure may extend from thereed to the support to couple the balanced armature transducer to thesupport in a first configuration. The structure extending from the reedto the support can be configured to decouple from at least the supportin a second configuration to remove the balanced armature transducerfrom the middle ear of the user.

In another aspect, embodiments of the present invention provide a methodof transmitting sound to an ear of a user, the ear having a roundwindow, the method comprising: transmitting an electromagnetic signal toa transducer coupled to a support, wherein the transducer vibrates theround window with the support.

In another aspect, embodiments of the present invention provide a methodof providing a hearing prosthesis to transmit sound to an ear of a user,in which the ear has a round window. A support and a transducer areprovided. The support is coupled with the round window of the ear suchthat the transducer is coupled to the round window with the support totransmit the sound.

In many embodiments, the transducer contacts the support and the supportis configured to separate from the transducer. The support may comprisea non-magnetic material.

In another aspect, embodiments of the present invention provide a deviceto transmit a sound to a user. The device comprises a transducer meansfor vibrating a round window of the user and a support means forcoupling the transducer means to the round window.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A shows an open canal hearing system comprising a BTE unit and atransducer coupled to a round window of a user with a support, inaccordance with embodiments of the present invention;

FIG. 1A1 shows a hearing system comprising an ear canal module and atransducer coupled to a round window of a user with a support, inaccordance with embodiments of the present invention;

FIG. 1B shows the lateral side of the eardrum and FIG. 1C shows themedial side of the eardrum, suitable for incorporation of the hearingaid system of FIG. 1;

FIG. 1D shows an output transducer assembly comprising a photodetectorcoupled to a coil, in which the coil is sized to fit at least partiallyin the round window niche to couple to a magnet positioned on a supportcoupled to the round window;

FIG. 1D1 shows an output transducer assembly comprising a balancedarmature transducer coupled to the round window;

FIG. 1E shows an output transducer assembly coupled to the round windowwith fascia, in accordance with embodiments;

FIG. 1E1 shows a magnet and support coupled to the round window withfascia, in accordance with embodiments;

FIG. 1E2 shows a magnet and support coupled to the round window with thesupport affixed to the round window and the magnet coupled to thesupport and configured for removal;

FIG. 1E3 shows an transducer assembly coupled to the round window with asupport and an extension such that the is transducer is configured todecouple from the support for removal of the transducer when the supportis affixed to the round window;

FIG. 1F shows a schematic illustration of a medial view of the outputtransducer assembly positioned in the middle ear of the user so as tocouple to the round window as in FIGS. 1D to 1E3;

FIGS. 1G1 and 1G2 show side and top views of the support with a firstconfiguration to hold the magnet and barrier configured to inhibittissue growth toward the magnet;

FIG. 1G3 shows the support as in FIGS. 1G1 and 1G2 with a secondconfiguration configured to release the magnet;

FIG. 1H shows support configured to hold the magnet with a firstconfiguration, and barrier configured to inhibit tissue growth towardthe magnet, in which the barrier extends laterally away from the magnet;

FIG. 1I1 shows support configured to hold the magnet with a firstconfiguration, barrier configured to inhibit tissue growth and anannular structure sized to receive fascia to hold the support in placeover the round window in accordance with embodiments;

FIG. 1I2 shows tissue structure of the round window suitable forcoupling in accordance with embodiments of the present invention;

FIG. 1J shows a magnet comprising a pair of opposing magnets, inaccordance with embodiments;

FIG. 1K shows an optical coupler comprising at least one optic to coupleto the light transmitted through the eardrum, in accordance withembodiments;

FIG. 1L shows the at least one optic of the coupler, in which the atleast one optic comprises a lens, in accordance with embodiments; and

FIG. 2 shows an experimental set up to determine optical transmissionthrough the tympanic membrane, in accordance with embodiments.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments as described herein can be used to transmit sound to a user.The sound may comprise sound from one or more sources such as amicrophone, a cell phone, a Bluetooth connection, for example. In manyembodiments, the sound is transmitted with a wireless signal through theeardrum such that the invasiveness of the surgery can be decreased. Thewireless signal may comprise electromagnetic energy that is transmittedthrough the eardrum. The electromagnetic energy may compriseelectromagnetic energy from a coil, for example. Alternatively or incombination, the electromagnetic energy may comprise light energytransmitted through the eardrum. The light energy my be transmittedthrough a posterior portion of the eardrum, for example through aninferior-posterior portion of the eardrum, so as to improve couplingefficiency of the light energy comprising the wireless sound signaltransmitted through the eardrum.

As used herein light encompasses infrared light, visible light andultraviolet light.

FIG. 1A shows an open canal hearing system 10. The hearing system 10comprises an input assembly 20 and an output assembly 30. The inputassembly 20 may comprise a behind the ear (hereinafter “BTE”) unit. Theoutput assembly 30 comprises a transducer 32 coupled to a round windowof a user with a support 32S.

The support 32S can be configured in many ways to couple the transducerto the round window. For example, the support 32S may comprise a softbiocompatible material sized for placement on the round window. Thesupport 32S may be coupled to the round window RW with a liquid, forexample an oil such as mineral oil, such that the support can be removedfrom the round window RW. The support may comprise many biocompatiblematerials, for example collagen, hydrogel, silicone, elastomer, siliconehydrogel. The support 32S can be configured to decouple from componentstransducer 32S, such transducer components can be separated from support32S. For example support 32S may comprise a biocompatible materiallyconfigured to affix to the round window RW. The support 32S may comprisea first configuration configured to retain magnet 32M and secondconfiguration configured to release magnet 32M to separate support 32Sfrom magnet 32M. The support 32M may comprise a non-magnetic materialsuch that the support 32S can remain affixed to the round window in thepresence of strong magnetic fields, for example with magnetic resonanceimaging.

The BTE unit can be configured in many ways. The BTE unit can bepositioned behind a pinna P of the user, so as to decrease visibility ofthe BTE unit. The BTE unit can house electronics used to process andinput signal. An input transducer of inputs assembly 10, for examplemicrophone 22, is coupled to the BTE unit and can transmit an audiosignal to the BTE unit. The BTE can convert the input signal into anelectromagnetic signal EM. The electromagnetic signal may comprise anoptical signal produced by at least one optical source such as a laser,or an electromagnetic signal from a coil. For example a support canextend into the ear canal and support a coil as described in asdescribed in U.S. application Ser. No. 12/244,266, entitled, “EnergyDelivery and Microphone Placement Methods for Improved Comfort in anOpen Canal Hearing Aid”, filed Oct. 2, 2008, the full disclosure ofwhich is incorporated herein by reference and may be suitable forcombination in accordance with embodiments of the present invention.Alternatively, the BTE unit can be coupled to an optical transmissionstructure 12 to emit an electromagnetic signal EM comprising the opticalsignal. The light transmission structure 12 can extend from the BTE intothe ear canal EC. The light transmission structure 12 may supportmicrophone 22. The light source may be housed in the BTE and coupled tothe light transmission structure 12. Alternatively, the light source maybe positioned in the ear canal, for example on a support disposed in theear canal.

The input of input assembly 20 can come from many sources such as amicrophone, a second microphone, or a radio coupled to an electronicsdevices such as a cell phone, computer, etc. Microphone 22 can bepositioned in many locations, for example within the ear canal or nearthe ear canal opening to detect sound localization cues. The inputtransducer may comprise a second microphone positioned on the BTE unitfor noise cancelation. The sound input to the assembly may comprisesound from a Bluetooth connection, and the BTE may comprise circuitry tocouple with a cell phone, for example. For example, the input transducerassembly may be located substantially within the ear canal, as describedin U.S. Pub. No. 2006/0251278, the full disclosure of which isincorporated by reference. The input transducer assembly may comprise ablue tooth connection to couple to a cell phone and my comprise, forexample, components of the commercially available Sound ID 300,available from Sound ID of Palo Alto, Calif.

The output assembly 30 is configured for placement at least partially inthe middle ear of the user. The output assembly 30 may comprise at leastone detector 34 configured to receive electromagnetic energy EMcomprising the optical signal λ_(S). The output assembly comprise maycomprise an output transducer, such that vibration of the transducerstimulates the cochlea in response to the optical signal. The outputassembly 30 may comprise many kinds of transducers to vibrate theauditory system such that the user perceives sound. For example, thetransducer may comprise at least one of a magnet, a coil, a coil andmagnet transducer, a piezoelectric transducer, a balanced armaturetransducer, a photostrictive transducer or a magnetostrictivetransducer.

The hearing system 10 can leave the natural hearing pathway of the usersubstantially function and intact with decreased interference from thesystem 10. Skin SK of the external ear can support the input assembly.The Pinna P can focus sound toward the ear canal EC, such that soundlocalization cues can be detected by microphone 22. The eardrum TM iscoupled to ossicles OS so as to conduct sound to the cochlea CO wherevibrations are sensed by the user as sound. The ossicles comprise amalleus ML, an incus IN and a stapes ST. The stapes ST couples to thecochlea with an oval window OW. The round window can be disposed along achannel of the cochlea opposite the oval window OW such that the roundwindow RW vibrates in response to sound. The round window may be locatedin a round window niche NI. The eardrum TM may comprise an annulus TMA.An incision may be formed in the eardrum TM and optionally in theannulus TMA to insert components the output assembly in the middle earME.

In many embodiments, the at least one detector 34 comprises aphotodetector, such as a photovoltaic diode, is positioned so as toreceive light energy transmitted through a posterior portion of theeardrum TM, for example through an inferior/posterior portion of theeardrum, and the photodetector can be positioned within a range fromabout 0.5 mm to about 2 mm from the eardrum so as to couple efficientlywith the light source. For example, the light source may be housed inthe BTE and an optical fiber extending from the BTE to the ear canaltransmits the light energy through the posterior portion of the eardrumto at least one detector.

FIG. 1A1 shows an input assembly 20 of system 10 comprising an ear canalmodule (hereinafter “ECM”). The ECM may comprise many of the componentsof the BTE unit and vice-versa. The ECM may be shaped from a mold of theuser's ear canal EC. Circuitry (Circ.) can be coupled to microphone 22.The circuitry may comprise a sound processor. The ECM may comprise anenergy storage device PS configured to store electrical energy. Thestorage device may comprise many known storage devices such at least oneof a battery, a rechargeable batter, a capacitor, a supercapacitor, orelectrochemical double layer capacitor (EDLC). The ECM can be removed,for example for recharging or when the user sleeps. The ECM may comprisea channel 29 to pass air so as to decrease occlusion. Although air ispassed through channel 29, feedback can be decrease due to coupling ofthe transducer or electrode array directly to tissue.

The energy storage device PS may comprise a rechargeable energy storagedevice that can be recharged in many ways. For example, the energystorage device may be charged with a plug in connector coupled to asuper capacitor for rapid charging. Alternatively, the energy storagedevice may be charged with an inductive coil or with a photodetector PV.The photodetector detector PV may be positioned on a proximal end of theECM such that the photodetector is exposed to light entering the earcanal EC. The photodetector PV can be coupled to the energy storagedevice PS so as to charge the energy storage device PS. Thephotodetector may comprise many detectors, for example black silicone asdescribed above. The rechargeable energy storage device can be providedmerely for convenience, as the energy storage device PS may comprisebatteries that the user can replace when the ECM is removed from earcanal.

The photodetector PV may comprise at least one photovoltaic materialsuch as crystalline silicon, amorphous silicon, micromorphous silicon,black silicon, cadmium telluride, copper indium gallium selenide, andthe like. In some embodiments, the photodetector PV may comprise blacksilicon, for example as described in U.S. Pat. Nos. 7,354,792 and7,390,689 and available under from SiOnyx, Inc. of Beverly, Mass. Theblack silicon may comprise shallow junction photonics manufactured withsemiconductor process that exploits atomic level alterations that occurin materials irradiated by high intensity lasers, such as a femto-secondlaser that exposes the target semiconductor to high intensity pulses asshort as one billionth of a millionth of a second. Crystalline materialssubject to these intense localized energy events may under go atransformative change, such that the atomic structure becomesinstantaneously disordered and new compounds are “locked in” as thesubstrate re-crystallizes. When applied to silicon, the result can be ahighly doped, optically opaque, shallow junction interface that is manytimes more sensitive to light than conventional semiconductor materials.Photovoltaic transducers for hearing devices are also described indetail in U.S. Patent Applications Nos. 61/073,271, entitled “OpticalElectro-Mechanical Hearing Devices With Combined Power and SignalArchitectures”; and 61/073,281, entitled “Optical Electro-MechanicalHearing Devices with Separate Power and Signal”, the full disclosures ofwhich have been previously incorporated herein by reference and may besuitable for combination in accordance with some embodiments asdescribed herein.

The output transducer assembly and anchor structure can be shaped inmany ways to fit within the middle ear and affix to structures therein.For example, the transducer assembly may comprise a cross sectional sizeto pass through an incision in the eardrum TM and annulus TMA, such thatbone that defines the ear canal can remain intact. The annulus TMA canbe supported by a sulcus SU formed in the bony portion of the eardisposed between the external ear and middle ear. The eardrum can beincised along the annulus to form a flap of eardrum, a portion of whicheardrum may remain connected to the user and placed on the margin of theear canal when the transducer assembly 30 is positioned in the middleear. Flap can be positioned after the transducer is positioned in themiddle ear. The transducer assembly may comprise at least a portionshaped to fit within a round window niche. Alternatively or incombination, transducer assembly 30 may comprise a rounded concaveportion 30R shaped to receive a rounded promontory of the middle ear.

The anchor structure can be configured to attach to many structures ofthe middle ear. For example, the anchor structure can be configured toaffix to bone of the promontory. Alternatively or in combination, theanchor structure may be configured to couple to a bony lip near theround window. For example fascia may be affixed to the bony lip andsupport so as to hold the support over the round window.

The BTE may comprise many of the components of the ECM, for examplephotodetector PV, energy storage device PS, the processor and circuitry,as described above.

FIG. 1B shows the lateral side of the eardrum and FIG. 1C shows themedial side of the eardrum, suitable for incorporation of the hearingsystem of FIGS. 1A and 1A1. The eardrum TM is connected to a malleus ML.Malleus ML comprises a head H, a manubrium MA, a lateral process LP, anda tip T. Manubrium MA is disposed between head H and tip T and coupledto eardrum TM, such that the malleus ML vibrates with vibration ofeardrum TM.

FIG. 1D shows output transducer assembly 30 comprising at least onephotodetector 34, an output transducer 32 and an anchor structure 36.The at least one photodetector 34 is coupled to an output transducer 32.The output transducer may comprise a coil 32C, in which the coil 32C issized to fit at least partially in the round window niche NI so as tocouple to magnet M positioned on support 32S coupled to the round windowRW. The output transducer 34 may be coupled to the coil 3C withcircuitry 38, such that the magnet vibrates to transmit sound inresponse to electromagnetic energy transmitted through eardrum TM.Output transducer assembly 30 may comprise an anchor structure 36configured to affix the output transducer assembly to a substantiallyfixed structure of the ear, such as promontory PR. The anchor structure36 may comprise a biocompatible structure configured to receive a tissuegraft, for example, and may comprise at least one of a coating, a flangeor holes for tissue integration. The anchor structure 36 can be affixedto tissue such that the location of the assembly remains substantiallyfixed when transducer 32 is coupled to the round window of the ear. Theat least one detector 34, the circuitry 38 and the coil 32C may behermetically sealed in a housing 32H, such that at least a portion ofhousing 32H comprising at least a portion of coil 32C is sized to fit atleast partially within the round window niche NI to couple the coil 32Cto the magnet 32M. The magnet 32M is sized to couple to the round windowRW.

The at least one photodetector may be configured in many ways to vibratethe round window in response to electromagnetic energy EM comprisinglight energy. For example, the assembly 30 may comprise a firstphotodetector configured to receive a first at least one wavelength oflight and a second photodetector configured to receive a second at leastone wavelength of light, in which the coil is configured to urge themagnet in a first direction 32M1 to increase the pressure of the innerear in response to the first at least one wavelength and to urge themagnet in a second direction 32M2 to decrease the pressure of inner earin response to the second at least one wavelength. The firstphotodetector may transmit the second at least one wavelength of lightsuch that the first photodetector can be positioned at least partiallyover the second photodetector to decrease the size of assembly 30. Thefirst photodetector can be coupled to the sound transducer with a firstpolarity and the second photodetector coupled to the secondphotodetector with a second polarity, the first polarity opposite thesecond polarity. The first photodetector and the second photodetectormay comprise at least one photovoltaic material such as crystallinesilicon, amorphous silicon, micromorphous silicon, black silicon,cadmium telluride, copper indium gallium selenide, and the like. In someembodiments, the at least one of photodetector may comprise blacksilicon, for example as described in U.S. Pat. Nos. 7,354,792 and7,390,689 and available under from SiOnyx, Inc. of Beverly, Mass.Alternatively or in combination, the assembly may comprise separatedpower and signal architectures, for example with the assembly comprisingone photodetector. The first at least one wavelength of light and thesecond at least one wavelength of light may be pulse width modulated.Examples of circuitry and systems that can be configured to opticallycouple the implantable transducer assembly 30 with input transducerassembly 20 can be found in U.S. App. Nos. 61/073,271, filed Jun. 17,2008, entitled “Optical Electro-Mechanical Hearing Devices With CombinedPower and Signal Architectures”; 61/139,522, filed Dec. 19, 2008,entitled “Optical Electro-Mechanical Hearing Devices With Combined Powerand Signal Architectures”; 61/139,522, filed May 11, 2009, entitled“Optical Electro-Mechanical Hearing Devices With Combined Power andSignal Architectures”; 61/073,281, filed Jun. 17, 2008, entitled“Optical Electro-Mechanical Hearing Devices with Separate Power andSignal”; 61/139,520, filed Dec. 19, 2008, entitled “OpticalElectro-Mechanical Hearing Devices with Separate Power and Signal”; Ser.No. 12/486,100 filed Jun. 17, 2009, entitled “Optical Electro-MechanicalHearing Devices With Combined Power and Signal Architectures”; Ser. No.12/486,116 filed Jun. 17, 2009, entitled “Optical Electro-MechanicalHearing Devices With Separate Power and Signal Components”; the fulldisclosures, all of which are incorporated by reference and suitable forcombination in accordance with embodiments of the present invention.

In some embodiments, the photodetector 34 may comprise output transducer32. For example the photodetector may comprise a photostrictive materialconfigured to vibrate in response to light energy.

FIG. 1D1 shows output transducer assembly 30 comprising a balancedarmature transducer 32BA coupled to the round window RW. The balancedarmature transducer 32BA comprises a reed 32BAR. Reed 32BAR is coupledto the round window RW with an extension structure, for example a post32BAP that extends from the reed toward the round window. The reed maybe coupled with support 32S similar configured to couple the transducerto the round window. In some embodiments, the extension may comprise thesupport. The balanced armature transducer is configured to couple to thesupport in a first configuration. The balanced armature transducer isconfigured to decouple from the support in a second configuration, forexample with decoupling of at least one of support 32S or post 32BAPfrom the transducer. For example, the reed may decouple from the post inthe second configuration. Alternatively or in combination, the extensionstructure comprising the post may decouple from the support 32S.

FIG. 1E shows output transducer assembly 30 coupled to the round windowwith fascia FA. The fascia FA can connect the transducer to the roundwindow niche. The transducer assembly can be configured to extend atleast partially within the round window to couple to the coil themagnet. The support may be releasably coupled to the round window, forexample with an oil such as mineral oil disposed between the support andthe round window to coat the support. Alternatively or in combination,the support may comprise a tissue growth inhibiting substance such thatthe support 32S does not become affixed to the round window, for examplewith tissue growth.

FIG. 1E1 shows a magnet and support coupled to the round window withfascia. The output transducer assembly may extend at least partiallyinto the window and couple to surgically positioned fascia FA, such thatthe output transducer assembly is held in place. The magnet and supportcan be retained in position over the round window with fascia FAsurgically positioned in the round window niche NI over the support 32S,magnet 32M, and round window RW such that the magnet and support areheld in place. The support 32S can be configured to inhibit scarring asdescribed above such that the support can be removed. Alternatively orin combination, the support can be configured to hold the magnet in afirst configuration and release the magnet in a second configuration.

FIG. 1E2 shows a magnet and support coupled to the round window with thesupport affixed to the round window and the magnet coupled to thesupport and configured for removal. Work in relation to embodimentssuggest that tissue can grow near the round window so as to connect tothe support, and the support can be configured to release the magnetsuch that the support remains in place on the round window when themagnet is removed. For example, scar tissue ST may grow toward thesupport and at least partially cover the support, such that the supportmay be affixed to the round window. A person of ordinary skill in theart can conduct experimental studies to determine the growth and extentof scar tissue formation in response to the support and magnet, or othertransducer coupling as described above. The support may comprise a firstconfiguration configured to couple to the transducer and a secondconfiguration configured to decouple from the transducer. The transducercan be removed from the middle ear of the user in the secondconfiguration.

FIG. 1E3 shows an transducer assembly coupled to the round window with asupport and an extension such that the transducer is configured todecoupled from the support for removal of the transducer when thesupport is affixed to the round window. The support is configured tocontact the round window with a first side. The scar tissue may formalong an outer portion of the support. The extension from the transducerto the support may be coupled to the support at an inner portion of thesupport, such that the extension and transducer can be decoupled fromthe support with a second configuration of at least one of theextension, the support or the transducer. For example, the extension maycomprise a post 32SP, which post can be decoupled from the both thetransducer 32 and the support 32S for removal of the transducer 32 andextension comprising post 32SP.

FIG. 1F shows a schematic illustration of a medial view the outputtransducer assembly positioned in the middle ear of the user so as tocouple to the round window as in FIGS. 1D to 1E3. Assembly 30 ispositioned in the middle ear behind eardrum TM. The at least onephotodetector 34 is configured to receive electromagnetic radiation andis oriented toward eardrum TM. The at least one photodetector 34 can bepositioned in the middle ear cavity so as to receive light energytransmitted through the posterior portion of the eardrum, for examplethrough a posterior/inferior portion of the eardrum. The photodetectorcan be positioned over the round window niche so as to coversubstantially the round window as seen from the medial view,corresponding to the path of light transmitted through the eardrum. Thedetector can be positioned about 0.5 mm to about 2 mm from the eardrum,and may comprise an optical coupler so as to couple to light energytransmitted through the eardrum. The support 32S can be positionedbetween the round window and at least one photo detector 34.

FIGS. 1G1 and 1G2 show side and top views of support 32S with firstconfiguration to hold the magnet and barrier 32SB configured to inhibittissue growth toward the magnet 32M. The barrier 32SB may comprise amaterial disposed so as to inhibit tissue growth toward the transducercomprising the magnet 32M. The barrier 32S may comprise knownbiocompatible materials with barrier properties, for example at leastone of an elastomer, a biocompatible plastic, or a hydrogel. The support32S may comprise a first side configured to couple to the round windowRW and a second side configured to couple to the transducer such asmagnet 32M. The barrier may extend in many ways along the second side toinhibit tissue contact at a location where the transducer such as magnet32M couples to the support. For example the barriers 32S may extendalong the second side away from the first side. The support may comprisestructures such as holes 32SIG for tissue integration.

The support comprises at least one structure 32SR to couple thetransducer to the support in a first configuration and to decouple thetransducer from the support in a second configuration. For example, thestructure may comprise biocompatible filaments that can be bent by asurgeon into a first configuration or a second configuration to couplethe transducer to the support or decouple transducer from the support,respectively. The at least one structure 32SR can be bent inwardly overthe magnet to retain the magnet. A person of ordinary skill in the artcan determine additional structures having the first configuration tocouple and the second configuration to decouple based on the teachingsdescribed herein.

FIG. 1G3 shows the support as in FIGS. 1G1 and 1G2 with a secondconfiguration configured to release the magnet.

FIG. 1H shows support 32S configured to hold the magnet with a firstconfiguration of at least one structure 32SR, and barrier 32SBconfigured to inhibit tissue growth toward the magnet, in which thebarrier 32SB extends along the second side laterally away from thelocation of the support where the transducer such as the magnet couplesto the support. The lateral extension of the support can be combinedwith extension away from the first side, as described above.

FIG. 1I1 shows support configured to hold the magnet with a firstconfiguration, barrier configured to inhibit tissue growth and anannular structure sized to receive fascia to hold the support in placeover the round window in accordance with embodiments.

FIG. 1I2 shows tissue structure of the round window suitable forcoupling in accordance with embodiments of the present invention.

The support may be formed from a mold formed with premixed Dow CorningSILASTIC™ silicone elastomer medical grade MDX4-4210 (ten parts of baseand one part of curing agent), for example. The magnet may be embeddedin the polymer for example. In some embodiments, the support may beformed from a mold the user, for example a mold of the round window. Themold may include a portion of the tissue that defines the round windowniche. The support can be formed from the mold of the user, such thatthe support is sized to the round window and the support may partiallycover the round window. A person of ordinary skill in the art canconduct experiments based on the teaching herein to determineempirically the dimensions of the support to couple to the round window,and the extent of any advantages of molding the support to the roundwindow of the user.

FIG. 1J shows magnet 32 of output assembly 30 comprising a pair ofopposing magnets. The pair of opposing magnets comprises a first magnet32M1 and a second magnet 32M2. The first magnet 32M1 and second magnet32M2 are arranged such that the magnetic field of each magnet opposesthe other magnet. This configuration can decrease sensitivity toexternal magnetic fields, for example transient magnetic fields that mayincrease user perceived noise and also decrease sensitivity to amagnetic fields from MRI machines, for example.

FIG. 1K shows an optical coupler comprising at least one optic 110 tocouple to the light transmitted through the eardrum. The at least oneoptic 110 can be positioned over the at least one photodetector betweenthe photodetector and the eardrum to improve coupling of the detector tothe light transmitted through the eardrum. The at least one optic maycomprise a substantially flat lower surface to couple to the at leastone photodetector. The at least one optic 110 may comprise an array oflenslets such as spherical lenses, cylindrical lenses, and combinationsthereof, for example.

FIG. 1L shows the at least one optic 110 of the coupler, in which the atleast one optic 110 comprises a lens, in accordance with embodiments.The at least one optic may comprise a geometric shape corresponding tothe shape of the eardrum to allow the optical coupler to be positionednear the eardrum to improve coupling efficiency of light transmittedthrough the eardrum. The at least one optic may comprise a lens, forexample one or more of a convex lens, a concave lens, a spherical lens,an aspheric lens, a cylindrical lens, a toric lens, and combinationsthereof. The shape may comprise one or more of many additional shapesthat correspond to the eardrum, for example the posterior portion of theeardrum, and may comprise a shape corresponding to the medial side ofthe eardrum to position the surface of the optic close to the eardrum.

Human Eardrum Transmission Experiment

The below described experiment was conducted to measure transmission ofinfrared light through the eardrum and determine arrangements of theinput assembly 20 and output assembly 30.

Objective: To determine the amount of light transmission loss through ahuman eardrum at posterior, inferior and anterior positions and theamount of scatter by the eardrum.

Procedure:

FIG. 2 shows the experimental set up to determine optical transmissionthrough the tympanic membrane, in accordance with embodiments. A fiberoptic coupled laser diode light source was aligned with a photodiodeoptical detector. An eardrum was placed in line and the change inoptical output from the photodiode determined. The eardrum is mounted toa x,y,z translation stage which allows a change to different positionsof the eardrum that the light goes through.

Materials:

Light source—1480 nm laser diode coupled to an optical fiber (250 umdiameter, 80 um core);

PhotoDiode—1480 nm photodiode (5.5 mm2);

Load—RLC electrical circuit equivalent to that of a balanced armaturetransducer coupled to a diaphragm, which can be suitable for determiningtransmission through the eardrum.

Collimation optics and a Neutral Density Filter (NE20B);

DC Voltmeter (Fluke 8060A);

Translation stages; and

Human cadaver eardrum with attached malleus (incus and other medialcomponents removed)

Results

No tympanic membrane

The current was set such that the photodiode was in the saturationregion. A neutral density (ND) filter was used to attenuate the lightoutput to reduced the PD response. The measurements indicate that the NDfilter attenuated the light source by 20.5 dB. This ensured that allmeasurements reported are from the linear region.

The photodiode voltage in response to the collimated light beam withoutthe eardrum was measured at the beginning of the measurements and at theend of experiment. The difference was less than 1%.

With no TM and ND filter, the output in mV was 349. With the ND filerand no TM, this output decreased to within a range from about 32.9 to33.1, corresponding to a linear change of 0.095 and −20.5 dB.

With Tympanic Membrane

Measurements were made at anterior, inferior, and posterior positions ofthe eardrum. The eardrum was moved at different locations relative tothe photodiode and it's distance X (in mm) approximated. Table 1 showsthe measured voltages corresponding to the different positions anddifferent eardrum locations.

TABLE 1 Measured photodiode voltages corresponding to transmission lossfrom the eardrum x (mm) 0.1 0.5 1 2 3 Posterior 28 mV 26.6 mV 25.4 mV23.4 mV 20.6 mV Inferior 23.6 mV 21.1 mV 17.1 mV Anterior 21.4 mV 20.2mV 18.2 mV

The posterior placement shows the highest voltage for all distances andhas values of 28, 26.6, 25.4 23.4 and 20.6 for distances of 0.1, 0.5, 1,2 and 3 mm, respectively.

For each eardrum position and location, the optical fiber was adjustedto maximize the PD voltage. This ensured that the light beam wasmaximally on the photodiode surface and that the measured response wasdue to transmission loss and not due to misalignments.

Calculations

The measured voltages were converted to percent transmission loss(hereinafter “TL”) as follows:% TL=((V _(NoTM) −V _(WithTM))/V _(NoTM))*100where V_(NoTM) is the measured voltage with no tympanic membrane andV_(WithTM) is the measured voltage with the tympanic membrane

Table 2 below shows the calculated % Transmission Loss using the aboveequation.

TABLE 2 % Transmission loss x (mm) 0.1 0.5 1 2 3 Posterior 16 20 23 2938 Inferior 29 36 48 Anterior 35 39 45 Average 29 35 44

At all locations the posterior placement showed the least transmissionloss and values of 16, 20, 23, 29 and 38% at distances of 0.1, 0.5, 1, 2and 3 mm, respectively.

With the PD very close to the eardrum (within about 0.1 mm), the TL isabout 16%. The TL could only be measured for the Posterior position.

Of the three positions of the eardrum, the posterior position is betterthan the inferior position by 6-10%, and better than the anteriorposition by 7-12%.

As the eardrum is moved away from the PD, the transmission lossincreases linearly for all three positions. The average transmissionloss is about 29%, 35%, and 44% averaged across the three differentpositions for the 1, 2 and 3 mm locations respectively.

Experimental Conclusions

The transmission loss due to the eardrum is lowest at the posteriorposition (16%). The loss increases as the photodiode is moved away fromthe eardrum due to scatter of the collimated beam by the eardrum. At 3mm from the eardrum, the average loss was as much as 44%. These datashown the unexpected result that there is more loss due to light scatterat angles away from the detector surface induced by the eardrum than dueto transmission of light through the eardrum, and the detector andcoupler such as a lens can be shaped appropriately so as to collecttransmitted light scattered by the eardrum. These data also show theunexpected result that light transmission is higher through theposterior portion of the eardrum.

As the eardrum can move, the detector in a living person should be atleast about 0.5 mm from the eardrum. The data suggest that a detectorand/or component such as a lens can be shaped to fit the eardrum andprovide improved transmission, for example shape with one or more of aninclined surface, a curved surface, and can be positioned within a rangefrom about 0.5 mm to about 2 mm, for example.

The above data shows that illuminating a portion of the eardrum andplacing a detector near the illuminated portion, for example can achievetransmission coupling efficiency between the projected light beam anddetector of a least about 50% (corresponding to 50% loss), for exampleat least about 60% (corresponding to 40% loss). With posterior placementof the detector and illumination of a portion of the posterior region ofthe eardrum, the coupling efficiency can be at least about 70%, forexample 80% or more. These unexpectedly high results for couplingefficiency indicate that illumination of a portion of the eardrum and adetector sized to the illuminated portion can provide efficiencies of atleast about 50%. Also, the unexpected substantially lower transmissionloss for the posterior portion of the eardrum as compared to each of theinferior and anterior portions indicates that transmission can beunexpectedly improved with posterior placement when most of the eardrumis illuminated. For example, the transmission coupling efficiency of theoptical fiber to the photodetector can be improved substantially whenthe photodetector is positioned in the posterior portion of the middleear cavity, for example the inferior posterior portion of the middle earcavity, and an optical fiber is positioned in the ear canal withoutcollimation optics such that light is emitted directly into the earcanal from the end of the optical fiber. Also, the high amount of lighttransmission through the eardrum shows that the optical signal can betransmitted through the eardrum, and that the sound encoded with theoptically signal transmitted through the eardrum can stimulate thecochlea with vibration transmitted through the round window.

While the exemplary embodiments have been described in some detail, byway of example and for clarity of understanding, those of skill in theart will recognize that a variety of modifications, adaptations, andchanges may be employed. Hence, the scope of the present inventionshould be limited solely by the appended claims and the full scope ofthe equivalents thereof.

What is claimed is:
 1. A device to transmit user perceivable sound to anear of a user, the ear having an eardrum, a middle ear, an ossicularchain within the middle ear, and a round window membrane located withina round window niche, the device comprising: a support configured tocouple to the round window membrane, the support sized for placement onthe round window membrane located within the round window niche; and atransducer configured to reside entirely within the middle ear and toreceive a signal representative of the user perceivable soundtransmitted wirelessly through the eardrum from an input, wherein thetransducer is further configured to affix to an anatomical structurewithin the middle ear without contacting the ossicular chain within themiddle ear when the transducer is positioned in the middle ear medial tothe eardrum and to couple to the round window membrane through thesupport when the support is placed on the round window membrane in orderto transmit the sound solely in response to the received signal, whereinthe input is configured to receive the user perceivable sound from anambient environment, process the received user perceivable sound togenerate the signal, and transmit the signal to the transducer.
 2. Thedevice of claim 1, wherein the support is disposed at least partiallybetween the transducer and the round window membrane to inhibit contactof the transducer and round window membrane.
 3. The device of claim 1,wherein the support is configured to decouple from round window membranewithout tearing tissue of the round window membrane.
 4. The device ofclaim 1, wherein the support is configured to be able to be decoupledfrom the transducer when the support is affixed to the round windowmembrane.
 5. The device of claim 4 wherein the support is configured toaffix to the round window membrane, and wherein the support isconfigured to decouple from the transducer to remove the transducer fromthe middle ear when the support is affixed to the round window membrane.6. The device of claim 4 wherein the support comprises a first side tocouple to the round window membrane and a second side opposite the firstside to couple to the transducer.
 7. The device of claim 6, wherein thesupport comprises an extension extending along the second side toinhibit tissue growth toward the transducer.
 8. The device of claim 7,wherein the extension extends along the second side parallel to thefirst side.
 9. The device of claim 7, wherein the extension extends awayfrom the first side along the transducer.
 10. The device of claim 7,wherein the second side of the support comprises a recess sized toreceive at least a portion of the transducer.
 11. The device of claim 4,wherein the support comprises a structure configured to hold thetransducer with a first configuration and release the transducer with asecond configuration.
 12. The device of claim 11, wherein the structurecomprises an extension configured to extend from the support to thetransducer, and wherein the extension is further configured to be ableto be decoupled from the transducer to release the transducer.
 13. Thedevice of claim 4, wherein the support comprises a first side configuredto couple to the round window membrane and a second side configured tocouple to the transducer.
 14. The device of claim 13, wherein thesupport comprises a first configuration to couple to the transducer anda second configuration to decouple from the transducer.
 15. The deviceof claim 1, wherein the support comprises a soft biocompatible materialconfigured to conform to the round window membrane.
 16. The device ofclaim 15, wherein the support comprises a thin flexible materialconfigured to deform with the round window membrane in response to thesound.
 17. The device of claim 15, wherein the support is composed of amaterial comprising at least one of collagen, silicone, hydrogel,biocompatible plastic, or elastomer.
 18. The device of claim 1, whereinthe support is configured to couple to a mucosal tissue disposed overthe round window membrane.
 19. The device of claim 1, wherein thesupport is configured to couple to the round window membrane with aliquid.
 20. The device of claim 19, wherein the liquid comprises an oil.21. The device of claim 1, wherein the transducer comprises at least oneof a magnet, a coil, the coil and the magnet, a piezoelectrictransducer, a photostrictive transducer, a balanced armature transduceror a magnetostrictive transducer.
 22. The device of claim 21, whereinthe transducer comprises the magnet and wherein the magnet is coupled tothe support.
 23. The device of claim 22, wherein the support comprises afirst side configured to couple to the round window membrane and asecond side coupled to the magnet.
 24. The device of claim 23, whereinthe support comprises a first configuration to couple to the magnet anda second configuration to release the magnet.
 25. The device of claim22, wherein the transducer comprises the coil and wherein the coil isconfigured for placement in the middle ear of the user to couple to themagnet on the support.
 26. The device of claim 21, wherein thetransducer comprises the balanced armature transducer and wherein a reedof the balanced armature transducer is coupled to the support to vibratethe round window membrane.
 27. The device of claim 26, wherein astructure extends from the reed to the support to couple the balancedarmature transducer to the support in a first configuration.
 28. Thedevice of claim 27, wherein the structure extending from the reed to thesupport is configured to decouple from at least the support in a secondconfiguration to remove the balanced armature transducer from the middleear of the user.
 29. The device of claim 26 wherein the input comprisesa light source to transmit light energy along an ear canal through theeardrum, and wherein the device further comprises a photodetector sizedfor placement in the middle ear and coupling to the balance armaturetransducer to transmit the sound to the user.
 30. The device of claim 1,further comprising an anchor coupled to the transducer to affix thetransducer to the anatomical structure within the middle ear of theuser.
 31. The device of claim 1, wherein the transducer has across-sectional size to pass through an incision made in the eardrum andan annulus of the ear of the user, the incision being made such thatbone defining an ear canal of the user remains intact.
 32. The device ofclaim 1, wherein the input comprises a light source to transmit thesignal as light energy along an ear canal of the user through theeardrum, and wherein the device further comprises a photodetector sizedfor placement in the middle ear and coupled to the transducer totransmit the sound to the user.
 33. A method of transmitting userperceivable sound to an ear of a user, the ear having an eardrum, amiddle ear, an ossicular chain within the middle ear, and a round windowmembrane located within a round window niche, the method comprising:receiving the user perceivable sound from an ambient environment;processing the received user perceivable sound to generate a signalrepresentative of the user perceivable sound; transmitting the signalwirelessly through the eardrum to a transducer coupled to a supportplaced on the round window membrane located within the round windowniche; and vibrating the round window membrane with the transducerthrough the support placed on the round window membrane solely inresponse to the wireless signal, wherein the transducer is positionedentirely in a middle ear medial to the eardrum without contacting theossicular chain within the middle ear and affixed to an anatomicalstructure within the middle ear.
 34. A method of providing a hearingprosthesis to transmit user perceivable sound to an ear of a user, theear having an eardrum, a middle ear, an ossicular chain within themiddle ear, and a round window membrane located within a round windowniche, the method comprising: positioning a transducer entirely in amiddle ear of the user medial to the eardrum and affixing the transducerto an anatomical structure within the middle ear, wherein the transduceris positioned in the middle ear without contacting the ossicular chainwithin the middle ear; and placing a support on the round windowmembrane located within the round window niche, such that the transduceris coupled to the round window membrane through the support placed onthe round window niche to transmit the sound to the user, wherein thetransducer is configured to receive a signal representative of the userperceivable sound transmitted wirelessly through the eardrum from aninput and transmit the user perceivable sound solely in response to thereceived signal, and wherein the input is configured to receive the userperceivable sound from an ambient environment, process the received userperceivable sound to generate the signal, and transmit the signal to thetransducer.
 35. The method of claim 34 wherein the transducer contactsthe support and the support is configured to separate from thetransducer.
 36. The method of claim 34 wherein the support comprises anon-magnetic material.
 37. The method of claim 34, wherein theanatomical structure within the middle ear to which the transducer isaffixed is a bone of a promontory of the middle ear.